Novel Acoustic Biomarker of Quality of Life in Left Ventricular Assist Device Recipients.
Novel Acoustic Biomarker of Quality of Life in Left Ventricular Assist Device Recipients.
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DOI：
10.1161/jaha.120.018588
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发表时间：
2021-03-16
影响因子：
5.4
通讯作者：
Karra R
中科院分区：
文献类型：
--
作者：
Mainsah BO;Patel PA;Chen XJ;Olsen C;Collins LM;Karra R
虽然泵设计的技术进步提高了生存率，但左心室辅助装置（LVAD）接受者的生活质量得到了不同程度的改善。需要优化LVAD支持以改善生活质量的方法。我们研究了从数字听诊器获得的声学特征是否可以预测LVAD接受者以患者为中心的结局。我们对24名LVAD接受者（8名HeartWare HVAD™，16名HeartMate 3 [HM 3]）的心前区声音进行了6个月的随访。受试者用数字听诊器记录他们的心前区声音，并每周完成一次堪萨斯城心肌病问卷调查。我们开发了一种新的算法来过滤记录中的LVAD声音。LVAD缓解声音的无监督聚类显示了不同的声学特征组。在16名HM 3受体中，6名（38%）具有独特的声学特征，我们将其称为脉冲同步声音，这是基于其与HM 3人工脉冲的时间关联。在基线时，使用脉冲同步声音的HM 3受体具有显著更好的堪萨斯城心肌病问卷评分（中位数，89.1 [四分位距，86.2-90.4]对比66.1 [四分位距，31.1-73.7]; P=0.03）和6个月研究期间（边际平均值，77.6 [95% CI，66.3-88.9] vs 59.9 [95% CI，47.9-70.0]; P<0.001）。在机械上，脉冲同步声音与患者来源的固有声音共享声学特征。最后，我们开发了一种机器学习算法来自动检测心前区声音中的脉冲同步声音（曲线下面积，0.95，留一个受试者交叉验证）。我们已经确定了一种新的声学生物标志物与更好的生活质量在HM 3 LVAD收件人，这可能提供一种方法来分析优化LVAD支持。
Although technological advances to pump design have improved survival, left ventricular assist device (LVAD) recipients experience variable improvements in quality of life. Methods for optimizing LVAD support to improve quality of life are needed. We investigated whether acoustic signatures obtained from digital stethoscopes can predict patient‐centered outcomes in LVAD recipients. We followed precordial sounds over 6 months in 24 LVAD recipients (8 HeartWare HVAD™, 16 HeartMate 3 [HM3]). Subjects recorded their precordial sounds with a digital stethoscope and completed a Kansas City Cardiomyopathy Questionnaire weekly. We developed a novel algorithm to filter LVAD sounds from recordings. Unsupervised clustering of LVAD‐mitigated sounds revealed distinct groups of acoustic features. Of 16 HM3 recipients, 6 (38%) had a unique acoustic feature that we have termed the pulse synchronized sound based on its temporal association with the artificial pulse of the HM3. HM3 recipients with the pulse synchronized sound had significantly better Kansas City Cardiomyopathy Questionnaire scores at baseline (median, 89.1 [interquartile range, 86.2–90.4] versus 66.1 [interquartile range, 31.1–73.7]; P=0.03) and over the 6‐month study period (marginal mean, 77.6 [95% CI, 66.3–88.9] versus 59.9 [95% CI, 47.9–70.0]; P<0.001). Mechanistically, the pulse synchronized sound shares acoustic features with patient‐derived intrinsic sounds. Finally, we developed a machine learning algorithm to automatically detect the pulse synchronized sound within precordial sounds (area under the curve, 0.95, leave‐one‐subject‐out cross‐validation). We have identified a novel acoustic biomarker associated with better quality of life in HM3 LVAD recipients, which may provide a method for assaying optimized LVAD support.